A. ADMINISTRASI
B. KONSULTASI
BAGI HASIL
NO KODE KETERANGAN TARIF (Rp)
Dr
1 K-001 Konsultasi Bidan 20,000
2 K-002 Konsultasi Dr.Umum Siang 45,000 22,500
3 K-003 Konsultasi Dr.Umum Malam 50,000 25,000
4 K-004 Konsultasi Dokter Gigi 50,000 21,500
5 K-005 Konsultasi Dokter Kecantikan 60,000 36,000
6 K-006 Konsultasi Dokter Spesialis 145,000 101,500
5 K-007 Konsultasi Dokter Spesialis by Phone 145,000 101,500
6 K-008 Konsultasi Dr Sub Spesialis 185,000 129,500
9 K-009 Konsultasi Dokter Umum Yankesga 35,000 17,500
10 K-010 Konsultasi Dokter Umum malam Yankesga 40,000 20,000
11 K-011 Konsultasi Dokter Umum Mandiri In Health (Garuda) 20,000 10,000
12 K-012 Konsultasi Dokter Umum Asuransi Adolay 40,000 20,000
13 K-013 Konsultasi Dokter Umum (pasien Dhuafa) 10,000 10,000
Catatan : Konsul by Phone berlaku untuk rawat inap dan rawat jalan.Konsul by Phone akan berubah menjadi visite
jika dokter yang merawat visite
F TINDAKAN BIDAN
file Keu/v/19
BAGI HASIL
Klinik
20,000
22,500
25,000
21,500
24,000
43,500
43,500
55,500
17,500
20,000
10,000
10,000
BAGI HASIL
Tarif
Dr Klinik
129,600 - 49,560
92,400 21,360 32,040
72,000 40,200 36,000
181,440 55,824 37,216
241,920 88,152 58,768
277,200 103,320 68,880
46,000 24,600 16,400
77,000 43,200 28,800
110,000 60,000 40,000
30,250 10,500 12,100
15,000 10,500 6,000
100,800 44,280 29,520
138,000 73,800 49,200
246,000 132,000 88,000
166,980 88,188 58,792
108,900 56,340 37,560
100,000 54,600 36,400 1020
365,700 199,620 133,080
317,400 170,640 113,760
276,000 145,800 97,200
227,700 118,620 79,080
248,000 129,000 86,000
910,000 525,000 350,000
50,000 9,300 6,200
80,000 16,020 13,350
150,000 23,520 19,600
100,000 28,020 23,350
200,000 17,220 14,350
110,880 57,528 47,940
100,000 44,100 36,750
150,000 69,600 58,000
200,000 95,100 79,250
100,000 51,000 34,000
55,000 27,500 27,500
70,000 33,000 22,000
20,000 12,000 5,000
60,000 36,000 24,000
70,000 27,000 18,000
98,000 40,200 26,800
20,000 10,000 5,000
60,000 33,000 22,000
25,000 - 19,000
25,000 15,000 10,000
1,000,000 450,000 300,000
1,700,000 930,000 620,000
700,000 330,000 220,000
1,800,000 930,000 620,000
1,500,000 750,000 500,000
150,000 75,000 75,000
200,000 100,000 100,000
50,000 25,000 25,000
210,000 92,250 107,250
360,000 92,250 267,750
BAGI HASIL
Tarif
Dr Klinik
15,000 10,000 2,000
150,000 84,000 56,000
400,000 180,000 120,000
BAGI HASIL
Tarif
Dr Klinik
15,000 10,000 2,000
50,000 22,500 22,500
40,000 10,000 -
70,000 10,000 10,000
350,000 150,000 100,000
600,000 300,000 200,000
110,000 57,000 38,000
120,000 60,000 55,000
300,000 60,000 40,000
60,000 30,000 27,000
40,000 20,000 17,000
40,000 20,000 17,000
150,000 100,000 45,000
75,000 50,000 22,000
150,000 100,000 45,000
100,000 50,000 45,000
150,000 100,000 45,000
BAGI HASIL
Tarif
Dr Klinik
15,000 10,000 5,000
20,000 12,000 5,000
-
65,000 60,000
318,500 313,500
250,000 245,000
230,000 225,000
370,000 365,000
94,000 89,000
254,000 249,000
332,000 327,000
450,667 445,667
150,000 145,000
900,000 895,000
25,000 20,000
972,500 967,500
230,000 225,000
253,500 248,500
330,000 325,000
217,000 212,000
536,250 531,250
50,000 45,000
816,000 811,000
656,500 651,500
150,000 145,000
160,000 155,000
451,000 446,000
329,900 324,900
643,500 638,500
331,500 326,500
BAGI HASIL
Tarif
Bidan Klinik
50,000 - 50,000
50,000 - 50,000
28,000 - 25,000
33,000 - 30,000
33,000 - 33,000
50,000 - 50,000
75,000 - 50,000
75,000 - 50,000
50,000 - 50,000
35,000 - 35,000
25,000 - 5,000
100,000 - 100,000
30,000 - 30,000
11,000 - 72,000
30,000 - 30,000
25,000 - 25,000
20,000 - 20,000
25,000 - 25,000
30,000 - 30,000
50,000 - 50,000
DAFTAR TINDAKAN DOKTER GIGI
KLINIK NAURA MEDIKA
BAGI HASIL
NO KODE KETERANGAN Tindakan BHP Tarif
Dr Klinik
1 G-001 Konsultasi dr Gigi + Premedikasi 63,000 7,000 70,000 34,650 31,500 10%
2 G-002 Open bur + Kapas 90,000 10,000 100,000 49,500 36,000 10%
3 G-003 Open bur + Trepanasi + Scalling penyebab abses 117,200 12,800 130,000 64,460 46,880 10%
4 G-004 Preparasi +TS 135,400 14,600 150,000 74,470 54,160 10%
5 G-005 Open bur + Arsen + TS 180,900 19,100 200,000 99,495 72,360 10%
6 G-006 Open bur + Arsen + TS + Inject 227,200 22,800 250,000 124,960 90,880 9%
7 G-007 Preparasi + Dycal + TS (Pulpcapping) 177,400 22,600 200,000 97,570 70,960 11%
8 G-008 Preparasi + GIC kecil 222,300 27,700 250,000 122,265 88,920 11%
9 G-009 Preparasi + GIC Besar 241,900 38,100 280,000 133,045 96,760 14%
10 G-010 Preparasi +Tambal sinar kecil 219,100 30,900 250,000 120,505 87,640 12%
11 G-011 Preparasi +Tambal sinar besar 266,600 33,400 300,000 146,630 133,300 11%
12 G-012 Preparasi + Tambal sinar Anterior kecil 267,100 32,900 300,000 146,905 106,840 11%
13 G-013 Preparasi + Tambal sinar Anterior besar 314,600 35,400 350,000 173,030 157,300 10%
14 G-014 Veneer Direct 455,600 44,400 500,000 250,580 227,800 9%
15 G-015 PSA + Irigasi + TS (tunggal) 183,900 16,100 200,000 101,145 91,950 8%
16 G-016 PSA + Irigasi + TS (tunggal) 283,900 16,100 300,000 156,145 113,560 5%
17 G-017 Irigasi + ganti obat PSA + TS (tunggal) 158,800 16,200 175,000 87,340 79,400 9%
18 G-018 Irigasi + ganti obat PSA + TS (ganda) 158,800 16,200 175,000 87,340 79,400 9%
BAGI HASIL
NO KODE KETERANGAN Tindakan BHP Tarif
Dr Klinik
19 G-019 Pengisian Pulputomi 227,000 23,000 250,000 124,850 113,500 9%
20 G-020 Pengisian Pulpectomi tunggal (Guttap) + GIC kecil 314,500 35,500 350,000 172,975 125,800 10%
21 G-021 Pengisian Pulpectomi ganda (Guttap) + GIC kecil 413,000 37,000 450,000 227,150 165,200 8%
22 G-022 Extraksi gigi sulung Chloretil 113,400 11,600 125,000 62,370 45,360 9%
23 G-023 Extraksi gigi sulung Injeksi 128,500 21,500 150,000 70,675 51,400 14%
24 G-024 Extraksi gigi tetap mudah 268,500 31,500 300,000 147,675 107,400 11%
25 G-025 Extraksi gigi tetap sulit 316,200 33,800 350,000 173,910 126,480 10%
26 G-026 Extraksi gigi tetap komplikasi I (bur tulang 2 amp + anastesi) 370,200 54,800 425,000 203,610 148,080 13%
27 G-027 Extraksi gigi tetap komplikasi I (bur tulang 2 amp + jahitan) 438,200 61,800 500,000 241,010 175,280 12%
28 G-028 Operculectomy 61,800 -
29 G-029 OD 3,500,000 50,000 3,550,000 2,450,000 1,750,000 1%
30 G-030 Implant by SpBM - -
31 G-031 Kontrol buka jahitan 139,700 10,300 150,000 76,835 55,880 7%
32 G-032 Scalling mudah 236,200 13,800 250,000 129,910 94,480 6%
33 G-033 Scalling sulit 285,700 14,300 300,000 157,135 142,850 5%
34 G-034 Scalling mudan + stand 285,700 14,300 300,000 157,135 142,850 5%
35 G-035 Scalling sulit + stand banyak 334,200 15,800 350,000 183,810 167,100 5%
36 G-036 Splinting (2 gigi) 84,200 15,800 100,000 46,310 42,100 16%
37 G-037 Splinting (tambahan gigi) 72,000 3,000 75,000 39,600 36,000 4%
38 G-038 Oklusal adjustment 136,700 13,300 150,000 75,185 68,350 9%
39 G-039 Cetak Alginate 146,450 13,550 160,000 80,548 58,580 8%
BAGI HASIL
NO KODE KETERANGAN Tindakan BHP Tarif
Dr Klinik
40 G-040 Plat GTSL + gigi pertama + Insersi 864,200 135,800 1,000,000 475,310 345,680 14%
41 G-041 Valplasi + gigi pertama (insersi) 1,129,200 370,800 1,500,000 621,060 451,680 25%
42 G-042 Valplasi + gigi selanjutnya 195,000 55,000 250,000 107,250 78,000 22%
43 G-043 Gigi tiruan lengkap (GTP) 1 rahang 2,852,300 647,700 3,500,000 1,568,765 1,140,920 19%
44 G-044 GTP ( Full Denture) 2 rahang 4,727,300 1,272,700 6,000,000 2,600,015 1,890,920 21%
45 G-045 Reparasi penambahan 1 gigi 369,200 80,800 450,000 203,060 184,600 18%
46 G-046 Reparasi dengan penambahan gigi selanjutnya 195,000 55,000 250,000 107,250 97,500 22%
47 G-047 Rebasing 579,200 220,800 800,000 318,560 231,680 28%
48 G-048 Jacket /crown aclirik 1,799,250 200,750 2,000,000 989,588 719,700 10%
49 G-049 Jacket /crown porselen 2,722,780 277,220 3,000,000 1,497,529 1,089,112 9%
50 G-050 Bridge (per gigi) minimal 3 gjgi 1,215,750 284,250 1,500,000 668,663 486,300 19%
51 G-051 Pasak ready made (tambahan jacket) 475,000 25,000 500,000 261,250 237,500 5%
52 G-052 Pasak cetak sendiri 520,000 180,000 700,000 286,000 208,000 26%
53 G-053 Sementasi tanpa pembuatan GTC 235,200 14,800 250,000 129,360 117,600 6%
54 G-054 Kontrol gigi palsu 93,200 6,800 100,000 51,260 46,600 7%
55 G-055 Uplay / Onlay 999,650 200,350 1,200,000 549,808 399,860 17%
56 G-056 Perbaikan GTC dengan composite 233,500 66,500 300,000 128,425 93,400 22%
57 G-057 Lepas GTC 1 crown 241,700 8,300 250,000 132,935 96,680 3%
58 G-058 Ortho metal tanpa pencabutan 3,943,700 556,300 4,500,000 2,169,035 1,577,480 12%
59 G-059 Ortho ceramic tanpa pencabutan 4,367,700 632,300 5,000,000 2,402,235 1,747,080 13%
60 G-060 Ortho ceramic dengan pencabutan 4,867,700 632,300 5,500,000 2,677,235 1,947,080 11%
BAGI HASIL
NO KODE KETERANGAN Tindakan BHP Tarif
Dr Klinik
61 G-061 Kontrol ortho I (ganti karet) 226,700 23,300 250,000 124,685 113,350 9%
62 G-062 Kontrol Ortho II ( ganti karet +kawat/ligature) 271,700 28,300 300,000 149,435 135,850 9%
63 G-063 Bracket 1 gigi 140,300 9,700 150,000 77,165 56,120 6%
64 G-064 Lem bracket 42,000 8,000 50,000 23,100 16,800 16%
65 G-065 Numpang kontrol ortho I (ganti karet) 284,700 15,300 300,000 156,585 142,350 5%
66 G-066 Numpang kontrol ortho II (ganti karet +kawat+ligature) 329,700 20,300 350,000 181,335 164,850 6%
67 G-067 Ortho lepasan (1 rahang) 746,700 153,300 900,000 410,685 373,350 17%
68 G-068 Retainer (1 rahang) 813,700 186,300 1,000,000 447,535 325,480 19%
69 G-069 Lepas ortho metal (ceramic) 343,000 7,000 350,000 188,650 137,200 2%
70 G-070 Lepas ortho metal (ceramic) pasien luar 343,000 7,000 350,000 188,650 137,200 2%
71 G-071 Bleaching 1,636,700 363,300 2,000,000 900,185 654,680 18%
file Keu/v/19
A. TINDAKAN DOKTER SPESIALIS THT
BAGI HASIL
NO KODE KETERANGAN Tarif
Dr
1 THT-001 Cerumen eksttraksi 1 telinga 75,000 67,500
2 THT-002 Ear toilet atau suction atau sedot 1 telinga 45,000 40,500
3 THT-003 Granulektomi 200,000 180,000
4 THT-004 Irigasi 1 telinga 90,000 81,000
5 THT-005 Garpu Tala (tes pendengaran) 45,000 40,500
6 THT-006 Perikondritis atau ot hematoma 250,000 225,000
7 THT-007 Ext.Corpal atau benda asing 1 Telinga 100,000 90,000
8 THT-008 Endoskopi telinga intip 75,000 67,500
9 THT-009 Endoscopi telinga print 125,000 112,500
10 THT-010 Paracintesis MT 200,000 180,000
11 THT-011 Periksa atau Audiometri + Baca 125,000 112,500
12 THT-012 Curretage canaliis 50,000 45,000
13 THT-013 Tampon atau off tampon canalis 75,000 67,500
14 THT-014 Patch MT atau myryngoplasti 350,000 315,000
15 THT-015 Incisi abses 150,000 135,000
16 THT-016 Cauterisasi AgNO3 100,000 90,000
17 THT-017 Pasang Grommet 250,000 225,000
18 THT-018 Baca Audiometri atau OAE -
19 THT-019 Biopsi Ekstirpasi Tumor Kecil 300,000 270,000
20 THT-020 Incisi abses Retroaurikular 350,000 315,000
21 THT-021 Biopsi Tumor 250,000 225,000
22 THT-022 Endoskopi tenggorokan intip 100,000 90,000
23 THT-023 Cauterisasi Elektrik 100,000 90,000
24 THT-024 Ext. Corpal atau benda asing 125,000 112,500
25 THT-025 Incisi abses 150,000 135,000
26 THT-026 Cauter Ag Nitrat 75,000 67,500
27 THT-027 Indirek laringoskopi kaca larynx 50,000 45,000
28 THT-028 Ganti Kanul Trachea 350,000 315,000
29 THT-029 Toilet atau suction atau sedot 1 hidung 45,000 40,500
30 THT-030 Biopsi tumor hidung 200,000 180,000
31 THT-031 Tampon anterior 100,000 90,000
32 THT-032 Tampon belioque 200,000 180,000
33 THT-033 Incisi abses hidung atau Septum 250,000 225,000
34 THT-034 Endoskopi biopsi NF 250,000 225,000
35 THT-035 Cauterisasi 50,000 45,000
36 THT-036 Ext.Corpal hidung atau benda asing 125,000 112,500
37 THT-037 Prov.Test sinus 100,000 90,000
38 THT-038 Punksi sinus maksila 1 hidung 450,000 405,000
39 THT-039 Ganti verband kecil (1-5 cm) 30,000 27,000
40 THT-040 Ganti verband sedang (6-10 cm) 40,000 36,000
41 THT-041 Ganti verband besar (>10cm) 55,000 49,500
42 THT-042 Ganti verband kecil khusus (1-5cm) 40,000 36,000
43 THT-043 Ganti verband sedang khusus (6-10cm) 60,000 54,000
44 THT-044 Ganti verband besar khusus (>10cm) 75,000 67,500
45 THT-045 Ganti verband Kompleks (dgn pus atau perdarahan) 100,000 90,000
46 THT-046 Jahit luka 1-5 jahitan 100,000 90,000
47 THT-047 Jahit luka 6-10 jahitan 135,000 121,500
48 THT-048 Jahit luka 11-15 jahitan 175,000 157,500
49 THT-049 Jahit luka 16-20 jahitan 200,000 180,000
50 THT-050 Jahit luka >20 jahitan 250,000 225,000
51 THT-051 Angkat jahitan 1-5 300,000 270,000
52 THT-052 Angkat jahitan 6-10 50,000 45,000
53 THT-053 Angkat jahitan >10 90,000 81,000
54 THT-054 Konsultasi Dokter 125,000 112,500
55 THT-055 Endoskopi hidung intip 100,000 90,000
56 THT-056 Cerumen eksttraksi 2 telinga 150,000 135,000
file Keu/V/19
BAGI HASIL
Klinik
7,500
4,500
20,000
9,000
4,500
25,000
10,000
7,500
12,500
20,000
12,500
5,000
7,500
35,000
15,000
10,000
25,000
-
30,000
35,000
25,000
10,000
10,000
12,500
15,000
7,500
5,000
35,000
4,500
20,000
10,000
20,000
25,000
25,000
5,000
12,500
10,000
45,000
3,000
4,000
5,500
4,000
6,000
7,500
10,000
10,000
13,500
17,500
20,000
25,000
30,000
5,000
9,000
12,500
10,000
15,000
PENUNJANG MEDIS
A LABORATORIUM
Hematologi
Darah Lengkap Rp. 125.000,-
Darah Rutin
Diff Count Rp. 50.000,-
Golongan Darah ABO + Rhesus Rp. 40.000,-
Protombin Time (PT) Rp. 185.000,-
APTT Rp. 150.000,-
INR Rp. 185.000,-
IT Ratio Rp. 100.000,-
LED (Laju Endap Darah) Rp. 40.000,-
Masa Perdarahan (BT) Rp. 30.000,-
Masa Pembekuan (CT) Rp. 30.000,-
Nilai MC Rp. 50.000,-
Paket Hapusan Darah Rp. 200.000,-
Malaria Rp.115.000,-
SI (Serum Iron) Rp. 120.000,-
TIBC Rp. 230.000,-
Ferritin Rp. 250.000,-
Hitung Eosinofil Rp. 65.000,-
Diabetes Mellitus
Glukosa Sewaktu Rp. 40.000,-
Glukosa Puasa Rp. 40.000,-
Glukosa 2 Jam PP Rp. 40.000,-
GTT Rp. 175.000,-
HBA1C Rp. 200.000,-
Faal Ginjal
Asam Urat Rp. 55.000,-
Ureum Rp. 55.000,-
Kreatinin Rp. 55.000,-
Faal hat
SGOT Rp. 60.000,-
SGPT Rp. 60.000,-
Bilirubin Total Rp. 60.000,-
Paket Bilirubin Dewasa (Total/Direk/Indirek) Rp. 165.000,-
Paket Bilirubin Bayi (Total/Direk/Indirek) Rp. 165.000,-
Paket Protein Total (Protein Total/Albumin/Globulin) Rp. 165.000,-
Protein Total Rp. 70.000,-
Albumin Rp. 60.000,-
Alkali Phospatase Rp. 70.000,-
Lemak
Cholesterol Lengkap Rp. 190.000,-
Cholesterol Total Rp. 55.000,-
HDL Cholesterol Rp. 65.000,-
LDL Cholesterol Direct Rp. 95.000,-
Trigliserida Rp. 55.000,-
Total lipid Rp. 110.000,-
Urinalisa
Urine Lengkap Rp. 60.000,-
Protein Urine Rp. 20.000,-
Glukosa urine Rp. 20.000,-
Feses
Feses Rutin Rp.95.000,-
Darah Samar/Bensidin Rp. 110.000,-
Hepatts
HBsAg (rapid) Rp. 85.000,-
HBsAg (kuantitatif) Rp. 143.000,-
Anti HCV Rp. 550.000,-
Anti HIV Rp. 650.000,-
Elektrolit
Natrium Rp. 115.000,-
Kalium Rp. 115.000,-
Chloride Rp.115.000,-
Kalsium Ion Rp. 210.000,-
Hormon
Β HCG Rp. 410.000,-
Free T3 Rp. 310.000,-
T4 Rp. 275.000,-
TSHs Rp. 250.000,-
Narkoba
Paket Narkoba Rp. 275.000,-
Serologi
Widal Rp. 100.000,-
Slamonella IgG/IgM (Tubex) Rp. 280.000,-
Dengue IgG/IgM (Dengue) Rp. 275.000,-
Ns1Ag Rp. 350.000,-
IgE Total Rp. 300.000,-
CRP Kuantitatif Rp. 300.000,-
ICT – TB Rp. 250.000,-
RF Kualitatif Rp. 130.000,-
RF Kuantitatif Rp. 200.000,-
Lain – Lain
Sputum BTA 3X Rp200.000,-
Sputum BTA 1X Rp. 70.000,-
B. FISIOTERAPI
file Keu/III/19
TARIF TINDAKAN RAWAT INAP
file Keu/III/19
A. ADMINISTRASI
B. TARIF KAMAR
KEU/I/2018
BAGI HASIL
Dr Klinik
PERKIRAAN BIAYA PERSALINAN
KETENTUAN UMUM
** Tarif merupakan perkiraan tarif sementara dalam keadaan normal/biasa
** Tarif belum termasuk obat dan alat kesehatan yang diresepkan,pemeriksaan laboratorium
radioogy dan penunjang medis lainnya
Kelas Perawatan
Keterangan
I II III
Kamar Bersalin 350,000 350,000 350,000
Perawatan Ibu 1,000,000 700,000 300,000
Perawatan Bayi 700,000 300,000 150,000
Bidan 650,000 550,000 400,000
Visite Dokter SpA 1 x 185,000 185,000 185,000
Obat injeksi dan alkes 231,762 231,762 231,762
Obat oral 193,050 193,050 193,050
CTG 1 x 72,000 72,000 72,000
Lab (Goldar) 40,000 40,000 40,000
Administrasi 50,000 35,000 25,000
3,471,812 2,656,812 1,946,812
B. PERKIRAAN BIAYA PERSALINAN NORMAL DENGAN DOKTER OBGYN
(Peawatan 2 hari)
Kelas Perawatan
Keterangan
I II III
Kamar Bersalin 350,000 350,000 350,000
Perawatan Ibu 1,000,000 700,000 300,000
Perawatan Bayi 700,000 300,000 150,000
Dokter Obgyn 1,800,000 1,500,000 1,200,000
Paramedis 300,000 300,000 300,000
Visite Dokter SpA 1 x 185,000 185,000 185,000
Obat injeksi dan alkes 341,394 341,934 341,934
Obat oral 193,050 193,050 193,050
CTG 1 x 72,000 72,000 72,000
Lab (Goldar) 40,000 40,000 40,000
Administrasi 100,000 75,000 50,000
Kelas Perawatan
Keterangan
I II III
Paket sewa kamar Operasi 4,500,000 4,200,000 4,000,000
Dokter Obgyn 2,500,000 2,100,000 1,800,000
Perawatan Ibu 1,500,000 1,050,000 450,000
Perawatan Bayi 1,050,000 450,000 225,000
GV 60,000 60,000 60,000
Paramedis 450,000 450,000 450,000
Visite Dokter SpA 1 x 185,000 185,000 185,000
Obat oral 351,728 351,728 351,728
Lab (Goldar) 40,000 40,000 40,000
Administrasi 100,000 75,000 50,000
Keterangan
BAGI HASIL
NO KODE KETERANGAN TARIF (Rp)
Dr
Visite Dokter Spesialis/hari
1 Kls-I Visite Dokter Spesialis
2 Kls-II
3 Kls-III
A. KAMAR PERAWATAN
BAGI HASIL
NO KODE KETERANGAN TARIF (Rp)
Dr Klinik
Visite Dokter Spesialis/hari
1 Kls-I Visite Dokter Spesialis
2 Kls-II
3 Kls-III
1 Konsultasi - - 145,000
2 O-001 Injeksi dr Spesialis 12,000 3,000 15,000
3 O-002 Vagina Toilet 45,000 5,000 50,000
4 O-003 USG 2 Dimensi intip (Kandungan) 35,000 5,000 40,000
5 O-004 USG 2 Dimensi Print (Kandungan) 60,000 10,000 70,000
6 O-005 USG 3 Dimensi 350,000 - 350,000
7 O-006 USG 4 Dimensi 600,000 - 600,000
8 O-007 CTG 110,000 - 110,000
9 O-008 GV 115,000 5,000 120,000
10 O-009 Papsmear 75,000 175,000 250,000
11 O-010 Kontrol Jahitan Post partum 57,000 3,000 60,000
12 O-011 Tindakan VT 37,000 3,000 40,000
13 O-012 Inspekulo 37,000 3,000 40,000
14 O-013 Pasang Ring 145,000 5,000 150,000
15 O-014 Cuci ring 72,000 3,000 75,000
16 O-015 Pasang IUD 145,000 5,000 150,000
17 O-016 Kontrol IUD 95,000 5,000 100,000
18 O-017 Aff IUD dr SpOG 145,000 5,000 150,000
19 Partus Kls I 1,500,000
20 Partus Kls II 1,350,000
21 Partus Kls III 1,180,000
21 Curetage 1,000,000
BAGI HASIL
Dr Klinik
101,500 43,500
10,000 2,000
22,500 22,500
10,000 25,000
10,000 50,000
350,000
600,000
110,000
60,000 55,000
75,000
30,000 27,000
20,000 17,000
20,000 17,000
100,000 45,000
50,000 22,000
100,000 45,000
50,000 45,000
100,000 45,000
900,000 600,000
810,000 540,000
708,000 472,000
600,000 400,000
TARIF AMBULANCE